Healthy SF to remove trans exclusions

NEWS

by Cynthia Laird

Nearly two years after a complaint was filed charging that
Healthy San Francisco, the city's health insurance program for uninsured
residents, is discriminatory because it excludes services for transgender
people, city officials are in the process of rectifying the situation and
including such services in the program.

Supervisor Scott Wiener and transgender leaders met with the
Bay Area Reporter Monday, July 16 and
said that city officials are expected to soon sign off on the changes that
would allow sexual reassignment services, treatment, and surgery to be covered
for transgender patients just as they are now for non-trans patients.

Barbara Garcia, the director of the Department of Public
Health, told the B.A.R. Monday that her
agency is committed to the changes, but that it would take another year to year
and a half before the administrative steps are implemented, due to contracting
requirements.

"We're totally committed to it," Garcia said.

Wiener introduced a resolution at Tuesday's board meeting
calling on the health department to "provide medically necessary
transition-related care for transgender people and to remove exclusions under
the San Francisco Health Care Security Ordinance," or Healthy SF.

Healthy SF is the city's locally designed and funded
universal health care program that was launched in 2007. It currently provides
hormone treatment and mental health services to transgender participants, but
administratively excludes sex reassignment surgery and denies coverage for
certain surgical procedures to transgender people when the same procedures are
provided to non-transgender participants, "thus denying transgender
residents equal access to necessary health care under this local plan,"
Wiener's resolution states.

For example, a Healthy San Francisco participant diagnosed
with breast cancer could have breast reduction surgery covered under the plan,
but a female-to-male transgender person could not have the same surgery covered.

Wiener said the costs would be negligible and pointed out
that when the city began offering similar benefits to its transgender employees
several years ago the actual cost was lower than the projections.

Cecilia Chung, a transgender woman who was former president
of the Human Rights Commission and who was recently appointed by Mayor Ed Lee
to the Health Commission, agreed.

"The benefits outweigh any costs," she said.
"It's removing barriers to transgender patients."

She also said that such services would be determined between
the doctor and patient.

"Most procedures are already being offered," Chung
said. "We want the process to be smooth but realistic."

The city spent approximately $150 million on Healthy SF in
fiscal year 2011-12, Wiener said.

Wiener's resolution noted the "insignificant" cost
of removing the exclusions and that inclusion "in fact provides cost
savings as well as significant benefits for the health, welfare, and safety of
the transgender population," according to a California Department of
Insurance study of actuarial data of five employers, including the city of San
Francisco.

It's been a long road for transgender leaders, who started
talking about the change nearly two years ago when the initial complaint was
filed.

"Since then, we've been negotiating with Barbara
Garcia, TLC, and the community group to move forward," said Human Rights
Commission Executive Director Theresa Sparks, who is transgender. "San
Francisco should be a center of excellence for transgender health."

Sparks and the other transgender advocates pointed to
Wiener's involvement being a key to accelerating the changes to Healthy SF.

"Scott brought energy to the discussion," Sparks
said.

Wiener; Sparks; Kristina Wertz, director of policy and
programs for TLC; and Masen Davis, executive director of TLC, also noted that
more private sector employers are now removing transgender health care
exclusions. The Human Rights Campaign, a national LGBT rights organization,
made providing such coverage part of its Corporate Equality Index and that,
too, has led to an increase in private sector companies coming on board. Those
firms run the gamut from Bank of America to Chevron Corp. to Intel.

As to the original complaint, Sparks said that her
department, the health department, and TLC held several mediation sessions with
the client and DPH agreed to provide the services under the city's general
services provision, not Healthy SF.

"The complaint shed light on the exclusion," Wertz
said Monday.

Some two years ago TLC and Lyon-Martin Health Services
established the Health Council, a local group formed to advocate around
transgender health care needs. Jackson Bowman, a transgender man, said this
week that he welcomes the announcement from city leaders.

"Removing the exclusion in Healthy SF is important.
There was a discriminatory element with the exclusions," Bowman said.

Bowman also pointed out the unique demographics of the
transgender population, noting that many are chronically underemployed or
in-between jobs. Bowman himself recently became unemployed, he said.